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General Post Stroke Care Guidelines

Learning objectives

  • Learning
  • Understand
  • Integrate
  • Reflect

Link to RCP Stroke Guidelines 2016
Use of Heparin for DVT Prophylaxis
  • Do not give heparin (in any dose) for the prevention of DVT and PE in patients who are immobile after acute stroke, and do not attempt to select those patients in whom the risk of VTE is sufficiently high to warrant the use of heparin.
  • Do use intermittent pneumatic compression instead (Section 3.13).
Managing AF
  • Do not treat recurrent TIA in patients in sinus rhythm with anticoagulants.
  • Do use antiplatelet treatment and investigate for carotid stenosis and paroxysmal atrial fibrillation before considering unusual causes of TIA or an alternative diagnosis (Section 3.3).
Role of Echo
  • Do not routinely perform echocardiography in people with stroke or TIA.
  • Do select those patients in whom an echocardiogram may be appropriate according to a history of structural cardiac disease or abnormal physical or ECG findings (Section 5.2).
Urinary catheter
  • Do not routinely use a urinary catheter or continence pads as first line management for people with continence problems after a stroke.
  • Do use behavioural interventions such as timed toileting and prompted voiding first (Section 4.5).
  • Do not routinely offer oral nutritional supplements to patients with acute stroke who are adequately nourished on admission.
  • Do assess hydration and risk of malnutrition in patients admitted to hospital with acute stroke (Section 4.7.1).
Slings and pulleys
  • Do not use overhead arm slings and pulleys in people with stroke who have functional loss in the arm.
  • Do ensure careful positioning of the affected arm and that carers and family handle the arm correctly (Section 4.12.3).
  • Do not assess driving eligibility with cognitive tests if the person's language impairment would invalidate the results.
  • Do refer for an on-road assessment if there is uncertainty about eligibility for driving (Section 4.1.3).
Occupational therapy
  • Do not routinely provide specialist occupational therapy for people who have reached the end of their stroke rehabilitation and are now living in a care home.
  • Do offer assessment and activities that might improve quality of life (Sections 2.17 and 5.9).
  • Do not routinely close a patent foramen ovale in a patient with stroke.
  • Do offer antiplatelet treatment for the prevention of recurrent stroke (Section 5.7).
  • Do not use fibrates, ezetimibe, bile acid sequestrants, nicotinic acid or omega-3 fatty acids for cholesterol-lowering after stroke if the patient is unable to tolerate a statin.
  • Do try alternative methods to improve the tolerability of a statin such as a reduced dose, alternateday dosing or a lower-intensity statin (Section 5.5).